i have undereye hollows, including tear troughs, without eye bags. may i know the recommended implants for this area, and the downsides of medpore implants to this area? for fat grafting, is it better to have the arcus relesed, together with open fat grafting, or a fat injections in minute amounts per injection?

Doctor Answers (7)

Different options depending on anatomy.

May 16th, 2012

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There are a lot of different anatomic features that we need to evaluate before giving you an opinion on this issue. And to be honest, if you post a photo, you might get five differing opinions. Different surgeons may be confident with different techniques, and they may all get improved outcome using these techniques.

If you have severe bony deficiency, an rim or tear trough or midface implant may be a good option, with possible fat addition. If its relatively mild soft tissue deficiency, a filler might be the best and least aggressive option. And many different options in between.

IMHO, I would not use or recommend fat grafting nor tear trough medpore implants. A photo of your face would be required for further evaluation. Suspension type Face Lifts tend to pull the lower eyelids down and not the much heavier cheeks up, IMO. If you truly only have lower lid hollows, a temporary filler would seem the best option IMHO.

Lower blepharoplsty and midface lift can help the hollow below the eyelid

March 30th, 2012

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The hollow below the eyelid responds well to a procedure I perform with midface lift and extended lower blepharoplasty. There is no graft, no implant, no fat transposition. Look at the picture at my page here on RealSelf , the first set under eyelid surgery, 41 year old mother of 4, who had lower blepharoplasty with midface lift and no fat removed.

If you posted a photo of your eyes taken without a flash we could get a better idea of what your particular problem is.

Eyelid Surgery Pictures

Treatment of the tear trough

March 30th, 2012

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With all of the lesser options available I would shy away from medpor or other facial implants for this problem. The risk benefit ration is much more infavor of injectable filers or fat grafting. Injecting fat even if you inject small droplets has a propensity to form lumps. For fat I prefer open placement of thin sheet grafts as the take rate is high and the incidence of lumps is low. You need to see a surgeon in consultation in order to fully understand the options available to you and then make an informed choice between these options.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Under eye filler is the safest option to fill undereye hollows

March 30th, 2012

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I agree with all of the concerns noted by Dr. Steinsapir. Given the issues with fat grafting and under eye implants, most surgeons that I work and speak with have shifted away from fat and implants and begun using mainly Restylane to fill this area. Given that you do not have undereye "bags" based on your description you would likely not benefit from lower eyelid surgery. Restylane IS temporary but it's also safe and predictable in the hands of an experienced injector.

It is impossible to fairly answer your questions without the benefit of even a photograph.

March 30th, 2012

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I personally do not think that orbital rim implants should be used just for cosmetic purposes. They simply require far too much surgery for an issue that can often be easily managed with under eye Restylane. I do this surgery to repair damaged eyelids after cosmetic lower eyelid surgery. Fat grafting to the lower eyelid also causes so many issues that I also do not recommend this. I see one or two patient a week who have had lower eyelid fat grafting and need the lumps removed surgically.

Under eye implants vs. fat grafting vs. fat injections

March 30th, 2012

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The area under the eyes can be tricky, and depends heavily on your age and anatomy. It sound like you don't have a big fat pocket to work with, but would like to soften the tear trough and smooth out the transition from the lower eyelid to the cheek. In patients without fat or tissue volume here, I find filler is usually the best option. Filler is cheaper than fat injection and I feel it gives a more predictable result. There is some risk of injection into a blood vessel, which could be catastrophic, so find an experienced facial plastic surgeon. Fat injection does work, but much of it is resorbed and it is much more expensive to harvest and process. Medpor implants have their place, but they are usually placed to augment the outer part of the cheek, making it more full. These require a larger surgery and can have complications such as lower eyelid retraction and infection. In patients who have some fat to spare in the lower eyelids, I feel arcus marginalis release with fat grafting is the best procedure as the fat doesn't resorb, it is permanently in place, and should look better for a longer period.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.